The pandemic transformed telehealth from a promising approach for improving healthcare access into a tool familiar to a wide range of Californians. Changes in norms, funding, and provider take-up that were prompted by the public health emergency have broadened access to telehealth among low-income and undocumented Californians.
Statewide telehealth use jumped dramatically among low-income Californians covered by Medi-Cal in March 2020, when telehealth visits began to be reimbursed at the same rates as in-person visits. We find comparable trends in California’s community health centers (CHCs)—primary care clinics that serve all comers—for Medi-Cal and undocumented patients.
Telehealth has the potential to reduce the barriers to health care for undocumented immigrants. For a forthcoming report, we interviewed experts in LA County—home to the state’s largest immigrant population and a significant proportion of its undocumented residents. These experts think telehealth helps patients who would otherwise experience transportation challenges, difficulty scheduling visits around work, and concerns about being exposed to immigration enforcement—even though CHCs are safe spaces, undocumented immigrants may be wary of in-person care.
However, telehealth can still pose challenges for those who are uncomfortable with technology or lack English proficiency. And while it was not the most salient concern in LA County, California’s persistent digital divide in access to broadband connection and devices can also be a barrier to using telehealth.
To get a sense of telehealth use among this population, we compared the medical visits of undocumented patients and their Medi-Cal counterparts in the same CHCs—in particular, we compared the likelihood that visits between January 2018 and November 2022 occurred over telehealth. Across the state, our analyses find similar rates of telehealth for undocumented and Medi-Cal patients. In LA County, however, being undocumented is associated with a higher likelihood of a visit occurring over telehealth, especially among those who are 26 and older.
California plans to continue many policies established during the public health emergency that broadened the availability of Medi-Cal-covered benefits and services through telehealth. And telehealth will continue to be an important resource for undocumented patients after Medi-Cal is expanded to all residents, regardless of age or immigration status, in January 2024. However, challenges lie ahead, particularly in addressing language barriers common among immigrants and enhancing technological literacy. PPIC’s forthcoming report on health and health care use among California’s undocumented immigrants will touch on these opportunities and challenges.